目的 探讨在关节镜下膝关节前交叉韧带损伤重建术治疗的临床效果。方法 选取2018年3月—2020年3月之间我院接受住院治疗的80名膝关节前交叉韧带损伤患者作为研究对象。根据手术方式的不同,常规手术进行交叉韧带损伤的重建术治疗为常规组,关节镜下膝关节前交叉韧带损伤重建术治疗为研究组,每组各40名患者,比对两组的治疗效果。结果 通过数据得出常规组的膝功能评分(71.8±12.6)及膝功能不稳评分(13.2±1.6)要低于研究组膝功能评分(83.9±12.9)及膝功能不稳评分(19.3±2.3),差异有统计学意义(P＜0.05)。在术后疼痛评分上研究组(3.35±0.23)各项数据均优于常规组(4.35±1.69),差异有统计学意义(P＜0.05)。研究组并发症发生率仅为5%,常规组并发症发生率有17.5%,研究组数据远要低于常规组,差异有统计学意义(χ^<sup>2=5.178,P=0.023)。结论 在膝关节镜下前交叉韧带损伤重建术治疗可有效改善膝关节活动性、稳定性、有效减轻患者的疼痛感,减少并发症的发生,促进膝关节功能的康复。关节镜下进行膝关节前交叉韧带损伤重建术治疗具有临床推广和采纳的价值。

Objective To investigate the clinical effect of arthroscopic anterior cruciate ligament (ACL) reconstruction. Methods 80 patients with ACL injury in our hospital from March 2018 to March 2020 were selected as the research objects. According to the different surgical methods, patients underwent the traditional open surgery for cruciate ligament injury reconstruction treatment were selected as the control group,patients underwent arthroscopic anterior cruciate ligament injury reconstruction treatment were as the study group, 40 patients in each group, the treatment effect of the two groups were compared. Results The Lysholm score (71.8±12.6) and and Lysholm instability score (13.2±1.6) of the control group were lower than those of the study group (83.9±12.9 and 19.3±2.3), the differences were statistically significant (P <0.05). In the postoperative pain score, the study group (3.35±0.23) data was better than the control group (4.35±1.69), the difference was statistically significant (P <0.05). The incidence of complications in the study group was only 2.5%, and that in the control group was 17.5%, which was significantly lower than the control group, and the difference was statistically significant (χ²= 5.178, P= 0.023). Conclusion Arthroscopic anterior cruciate ligament reconstruction can effectively improve the activity and stability of knee joint, effectively reduce the pain of patients, reduce the occurrence of complications, and promote the rehabilitation of knee joint function. Arthroscopic anterior cruciate ligament reconstruction has the value of clinical promotion and adoption.

目的 探讨瑞格列奈联合胰岛素治疗2型糖尿病临床疗效及对患者血糖水平的影响效果。方法 选取我院2019年1月—2021年1月收治的2型糖尿病患者324例,用随机数字法分为两组,每组各52例,对照组应用胰岛素治疗,研究组应用瑞格列奈联合胰岛素治疗。对两组2型糖尿病患者的临床疗效、血糖水平(FPG指数、2 h PG指数、HbA1c指数)以及胰岛素水平(HOMA-β水平、HOMA-IR水平)进行比较。结果 研究组疗效高于对照组(P＜0.05);研究组治疗后血糖指数优于对照组(P＜0.05);研究组治疗后胰岛素水平优于对照组(P＜0.05)。结论 2型糖尿病患者在治疗时,应用瑞格列奈联合胰岛素治疗,可增强治疗疗效,有效控制血糖水平,改善胰岛功能,从而促进疾病转归,具有极大的推广价值。

Objective To investigate the clinical efficacy of repaglinide combined with insulin in the treatment of type 2 diabetes mellitus and its effect blood glucose level. Methods A total of 324 patients with type 2 diabetes admitted to our hospital from January 2019 to January 2021 were randomly divided into two groups with 52 patients in each group. The control group was treated with insulin, and the research group was treated with repaglinide combined with insulin. Clinical efficacy, blood glucose level (FPG index, 2HPG index, HbA1c index) and insulin level (HOMA-β level, HOMA-IR level) of patients with type 2 diabetes were compared between two groups. Results The therapeutic effect of the research group was higher than that of the control group (P<0.05). The glycemic index of the research group was better than that of the control group (P<0.05). The insulin level in the research group was better than that in the control group (P<0.05). Conclusion In the treatment of type 2 diabetes mellitus, the application of repaglinide combined with insulin can enhance the therapeutic effect, effectively control the blood glucose level, improve the islet function, so as to promote the outcome of the disease, which has great promotion value.

目的 分析肝脓肿的临床基线及病原学特征,旨在提高临床对该病早期识别、病原体预判、并发症警惕及抗感染治疗能力。方法 收集广州番禺区中心医院2019年1月—2020年11月收治的肝脓肿病例相关临床及实验室资料。按病原体培养结果分成阳性组、阴性组。阳性组中,按不同致病菌分成肺炎克雷伯及非肺炎克雷伯亚组。比较不同组别间基线特征及实验室数据。结果 共收集肝脓肿71例,病原学培养阳性率83.1%(59例),其中肺炎克雷伯菌46例(80%)。最常见合并症包括糖尿病(54.9%)、胆道疾病(56.3%)、肺部感染(67.6%)等。病原体阳性组PCT和AST水平高于阴性组(P<0.05),但是两组之间基线特征无差异(P>0.05)。肺炎克雷伯亚组与其他病原体组相比,合并糖尿病的风险更高(P=0.007),PLT、PCT、ALT、AST和白蛋白的水平具有显著差异(P <0.05)。经过积极治疗,大多预后良好,未见死亡病例,其中7例患者发生严重侵袭性脓肿,遗留后遗症。结论 病原体阴性肝脓肿致病力方面与阳性组并无差别。肺炎克雷伯杆菌已成为肝脓肿中最常见菌群,其多见于合并糖尿病患者。其PLT、PCT、ALT、AST指标明显高于其他菌群组,伴白蛋白消耗明显。少数可伴有全身严重侵袭性脓肿。

Objective To investigate the clinical and etiological characteristics of pyogenic liver abscess (PLA) as a reference for its early identification,early prediction of pathogens, alertness to complications and rational antibacterial treatment. Methods A single center retrospective study was carried out in patients with PLA in Guangzhou Panyu Center Hospital from January 2019 to November 2020.The clinical and laboratory data of all liver abscess cases were concluded. Baseline characteristic and laboratory outcomes were grouped into Klebsiella pneumoniae group and non-Klebsiella pneumoniae subgroup according to different pathogenic bacteria. Results Among a total of 71 patients with liver abscess, 83.1%(n=59)had positive cultures. Klebsiella pneumoniae accounted for the most in 46 cases (80.0%). The most common complications included diabetes(50.7%), biliary tract disease(56.3%), pulmonary infection(67.6%) etc. The levels of PCT and AST in pathogen culture-positive group were higher than those in culture-negative group, with statistical significance (P<0.05),on the contrary there were no differences in baseline characteristic among the groups according to the results of pathogens. Compared with other pathogens, the group of Klebsiella pneumoniae liver abscess presented higher risk of diabetes.The levels of PLT, PCT, ALT, AST,and albumin in the two groups were different (P<0.05). Most patients had good outcomes, while 7 patients had residual problems represented with severe invasive abscess. Conclusion There were similar consequences between negative and positive liver abscesses. Klebsiella pneumoniae has become the most common bacteria in liver abscess. Among which, PLT、PCT、ALT、AST indexes are higher than that of other bacteria with obvious albumin depletion, even some of which may be accompanied by systemic severe invasive abscess.

目的 探讨选择性会阴侧切术对会阴体及产后盆底功能的影响。方法 选取2018年1月—2019年12月在广州市红十字会医院顺产的初产妇作为研究对象,研究组为选择性会阴侧切组、对照组为常规治疗,统计两组的会阴裂伤情况,盆底Ⅰ类肌、Ⅱ类肌肌力分级,POPQ评分的分级,肛提肌裂孔扩张情况。结果 会阴裂伤率:研究组2.5%,对照组为56.22%,连续性校正χ²为53.14,连续性校正P＜0.05。盆底Ⅰ类、Ⅱ类肌力＜3级发生率:研究组分别为30%、23%,对照组分别为 49%、38%,χ²分别为9.03、5.96,P＜0.05。POPQ 0级率:研究组26.25%,对照组12.5%,χ²为4.84,P＜0.05。肛提肌裂孔无扩张率:研究组16.25%,对照组为5%,χ²为5.33,P＜0.05。结论 在本研究中,与对照组相比,研究组会阴裂伤率、盆底肌力<3级发生率更低;盆腔器官无脱垂率、肛提肌裂孔无扩张率更高。选择性会阴侧切术对会阴体及盆底功能具有保护作用。

Objective To investigate the effect of selective lateral episiotomy on perineal body and pelvic floor function. Methods The primiparas who delivered naturally in Guangzhou Red Cross Hospital from January 2018 to December 2019 were selected as the research subjects. The research group were given selective lateral episiotomy, while the control group were given conventional treatment. The incidence of perineal laceration, pelvic floor muscle strength lower than grade 3, the POPQ score and levator ani hiatus dilatation were analyzed. Chi-square test was used to analyze the incidence of the two groups. Results The incidence of perineal laceration in the research group was 2.5% vs 56.22% in the control group(χ²=53.14, P<0.05). The incidence of pelvic floor muscle(group I) strength lower than grade 3 in the research group was 30% vs 49% in the control group(χ²=9.03, P<0.05). The incidence of pelvic floor muscle(group II) strength lower than grade 3 in the research group was 23% vs 38% in the control group(χ²=5.96, P<0.05). The rate of the incidence of POPQ 0 in the research group was 26.25% vs 12.5% in the control group (χ²=4.84,P＜0.05). The incidence of levator ani hiatus dilatation in the research group was 16.25%, while 5% in the control group (χ²=5.33, P<0.05). Conclusion Compared with conventional treatment group, selective lateral episiotomy group has a lower incidence of perineal laceration and pelvic floor muscle strength lower than grade 3. Selective lateral episiotomy group has a higher incidence of POPQ 0 and no levator ani hiatus dilatation. Selective lateral episiotomy can protect the perineal body and pelvic floor function.

目的 探讨I¹³¹联合促甲状腺激素(TSH)抑制治疗对术后中高危组甲状腺乳头状癌(PTC)患者心肌纤维化及心房颤动(AF)的影响。方法 选取2016年8月—2017年8月南华大学附属第一医院收治的因PTC行甲状腺双侧腺叶全切术或近全切除术患者69例,根据复发危险度分层分为中危组(49例)和高危组(20例), 两组患者均行I¹³¹ 联合TSH抑制治疗,治疗后嘱患者3个月进行1次复诊或自觉不适及时复诊,观察患者心血管系统症状、心房颤动及心肌纤维化发生情况,患者治疗前后可溶性基质溶素-2(sST2)、生长分化因子-15(GDF-15)、半乳糖凝集素-3 (GAL-3)及血清乳酸脱氢酶(LDHA)含量变化。结果 I¹³¹联合TSH抑制治疗后患者心房颤动发生率和心肌纤维化相关指标水平明显高于治疗前,且高危组患者治疗后心房颤动发生率和心肌纤维化相关指标水平高于中危组,差异均有统计学意义(P<0.05)。结论 I¹³¹联合TSH抑制治疗会增加PTC患者心肌纤维化和心房颤动的发生概率,且高危组PTC患者心肌纤维化和房颤的发生率高于中危组。

Objective To investigate the impact of I¹³¹ combined with thyroid-stimulating hormone(TSH) for suppressive treatment on myocardial fibrosis(MF) and atrial fibrillation(AF) in patients with papillary thyroid (PTC). Methods 69 patients with PTC undergoing total or subtotal thyroidectomy admitted into First Affiliated Hospital of University of South China from Aug. 2016 to Aug. 2017 were selected and divided into middle-risk group (49 cases) and high-risk group (20 cases) according to the recurrence risk stratification. Two groups of patients were given I¹³¹ combined with thyroid-stimulating hormone for suppressive treatment. The patients were instructed to undergo a follow-up visit every 3 months after treatment or whenever felt unwell. The incidences of cardiovascular system symptoms, atrial fibrillation and myocardial fibrosis, changes of contents of serum soluble ST2 (sST2), growth differentiation factor-15 (GDF-15), galectin-3 (GAL-3) and lactate dehydrogenase A (LDHA) were observed. Results After I¹³¹ combined with thyroid-stimulating hormone suppressive treatment, the incidences of atrial fibrillation and myocardial fibrosis after treatment were higher than that before treatment, and the incidences of atrial fibrillation and myocardial fibrosis of high-risk group were higher than those of the middle-risk group, with statistically significant differences (P＜0.05). Conclusion Combined use of I¹³¹ and thyroid-stimulating hormone for suppressive treatment can increase the incidences of atrial fibrillation and ventricular remodeling of patients with PTC, and the incidences of high-risk group were higher than those of the middle-risk group.

目的 探讨无症状感染者在新冠肺炎家庭聚集性疫情中的传播风险,分析家庭聚集性疫情中所有患者的住院治疗情况,为防控策略和治疗方案制定提供依据。方法 通过现场流行病学调查获得旅居史和暴露危险因素,并收集临床治疗资料,利用统计软件进行作图和分析。结果 指示病例的潜伏期为15天,其余4名家庭成员的潜伏期为1～15天,其中指示病例作为无症状感染者,在感染后第4～6天内具有传染性相继导致4名成员感染;指示病例携带病毒8天以上,其余4人从2天到31天不等; 症状持续时间5~20天,住院期间共进行CT检查次数为4～10次,肺部炎症最快在住院第三天好转。发病初期只有1个病例出现白细胞、淋巴细胞降低。发病到就诊和住院的时间间隔为1～10天,平均住院时间为23.4天。结论 无症状感染者在家庭聚集性疫情传播中具有关键作用,难以及时发现,存在较大传播风险,为新冠肺炎疫情防控带来较大难度。

Objective To study the transmission risk of asymptomatic patient in a family-clustered outbreak of new coronavirus pneumonia, analyze the hospitalization,and provide a basis for prevention strategies and treatment plan. Methods We collected the information about residence history and exposure risks by onsite epidemiological investigation, and collected clinical treatment-related data, used statistical software for mapping and analysis. Results The incubation period of the indicated case was 15 days, and the incubation period of the remaining four family members were 1-15 days. The indicated case as an asymptomatic patient had infectious succession within 4-6 days after infection,and four family members were infected one after another. The indicated case carried the virus for more than 8 days, and the remaining 4 patients ranged from 2 to 31 days. The duration of symptoms was 5-20 days of all 5 patients, and the number of CT examinations during hospitalization was 4-10 times. The pulmonary inflammation was improved on the third day of hospitalization at best. In the early stage of the disease, only one patient had leukopenia and lymphopenia decreased. The interval between onset and hospitalization was 1-10 days for five family members, with an average hospitalization time of 23.4 days. Conclusion The asymptomatic infected patient of COVID-19 plays a key role in the family convergence epidemic transmission. The symptoms are inapparent, so it is difficult to find in time. It will cause the risk of infection and increase the difficulty of COVID-19 prevention and control.

目的 探究椎间孔镜下治疗腰椎间盘突出症切除黄韧带对腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度的影响。方法 选择120例腰椎间盘突出症患者,随机分为观察组与对照组各60例。观察组患者椎间孔镜术中切除部分黄韧带;对照组患者保留黄韧带。比较两组患者术后半年、1年及2年的腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度。结果 观察组术后半年、1年腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度与对照组比较(P＞0.05)。观察组术后2年与对照组比较(P＜0.05)。结论 椎间孔镜下治疗腰椎间盘突出症保留黄韧带术后腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度远期效果优于切除黄韧带。

Objective To explore the effects of ligamentum flavum resection on lumbar lordosis angle, sacral inclination angle, lumbar curve index and height of intervertebral space. Methods 120 patients with lumbar disc herniation were randomly divided into observation group and control group. In the observation group, part of the ligamentum flavum was excised by endoscope and in the control group, the ligamentum flavum was preserved. The lumbar lordosis angle, sacral inclination angle, lumbar curve index and intervertebral space height of the two groups were compared at 6 months, 1 year and 2 year after operation. Results At 6 months, 1 year after operation, the lumbar lordosis angle, sacral inclination angle, lumbar curve index and height of intervertebral space in the observation group were compared with those in the control group(P＞0.05). 2 years after operation, the observation group was compared with the control group(P<0.05). Conclusion The long-term effect of ligamentum flavum preserving on lumbar lordosis angle, sacral inclination angle, lumbar curve index and height of intervertebral space is better than that of ligamentum flavum resection.

目的 探讨老年中度急性胆囊炎患者采用经皮经肝胆囊穿刺引流术与腔镜胆囊切除术联合治疗的效果。方法 本文将2019年2月—2020年2月收治的60例老年中度急性胆囊炎患者作为研究对象,按照随机数字表法分组,对照组30例患者仅采用择期腔镜胆囊切除术治疗,观察组30例患者在对照组的基础上应用经皮经肝胆囊穿刺引流术治疗。统计分析体液免疫指标、细胞免疫指标、手术前后ALP、TBIL、IBLL水平、AMY水平、白细胞计数、VAS评分及并发症发生情况。结果 两组之间ALP、TBIL、IBLL水平、AMY水平、白细胞计数、VAS评分及并发症发生情况相比,观察组低于对照组;体液免疫指标、细胞免疫指标相比,观察组高于对照组,P＜0.05。结论 在采用择期腔镜胆囊切除术治疗老年中度急性胆囊炎的基础上联合经皮经肝胆囊穿刺引流术可提升疗效,降低择期腔镜胆囊切除术的风险,有助于患者术后尽快恢复,还可减轻患者的免疫功能损伤情况,改善体液免疫指标,减轻疼痛程度,降低并发症发生率,具有较高的应用价值。

Objective To investigate the effect of combined treatment of percutaneous transhepatic cholecystectomy and endoscopic cholecystectomy in elderly patients with moderate acute cholecystitis. Methods The research objects were 60 elderly patients with moderate acute cholecystitis, grouping according to random number table method, the control group of 30 cases were treated with selective endoscopic cholecystectomy, the observation group of 30 patients were treated with the percutaneous liver gallbladder puncture drainage on the basis of selective endoscopic cholecystectomy. Statistical analysis of humoral immunity, cellular immunity, ALP, TBIL, IBLL levels before and after operation, AMY, white blood cell count, VAS score and complications were conducted. Results The levels of ALP, TBIL, IBLL, AMY, WBC count, VAS score and complications in the observation group were lower than those in the control group. The indexes of humoral immunity and cellular immunity in the observation group were higher than those in the control group (P<0.05). Conclusion Endoscopic cholecystectomy used in the treatment of elderly moderate acute cholecystitis combined on the basis of percutaneous transhepatic gallbladder puncture drainage can improve curative effect, reduce the risk of selective endoscopic cholecystectomy, help patients with postoperative recovery, also can reduce the patient's immune function damage, improve the humoral immunity indexes, relieve pain, reduce the incidence of complications, which has high application value.

目的 观察右美托咪定作为佐剂对罗哌卡因在锁骨上入路臂丛神经阻滞效果的影响。方法 将55例上肢择期手术的受试者随机分为右美组和对照组。右美组:30 μg右美托咪定(0.3 mL)＋0.5%罗哌卡因,对照组:生理盐水(0.3 mL)＋0.5%罗哌卡因。在臂丛神经阻滞操作后,按步骤评估和记录臂丛感觉、运动阻滞程度和起效时间。在术中定期监测和记录生命体征、不良事件的发生。手术后评估和记录术毕24小时生命体征、术后镇痛时间、臂丛神经感觉、运动阻滞的持续时间、术后恶心呕吐评分、补救镇痛药物用量和不良事件等数据。结果 在臂丛神经的感觉和运动起效时间、感觉和运动阻滞持续时间、术后镇痛时间方面,右美组长于对照组,存在统计学差异(P<0.05)。两组间在术后生命体征变化、补救镇痛药物用量、术后恶心呕吐评分、不良事件等数据的比较,未见明显统计学差异(P>0.05)。结论 右美托咪定(30 μg)作为佐剂能加快罗哌卡因在锁骨上入路对臂丛神经阻滞的起效时间,增加其术后镇痛时间和对臂丛神经的感觉、运动阻滞时间,同时较少影响患者生命体征,具备一定的有效性和临床安全性。

Objective To observed the effect of dexmedetomidine as an adjunction with ropivacaine in supraclavicularbrachial plexus block. Methods 55 subjects with elective upper extremity operation were randomly divided into two groups: DEX group and control group. The drugs in DEX group was 30 μg dexmedetomidine (0.3 mL) + 0.5% ropivacaine, 20 mL in total. And the one in control group was normal saline (0.3 mL) +0.5% ropivacaine, 20 mL in total. After the operation of brachial plexus block, the value of sensory and motor block of brachial plexus and the onset time were evaluated and recorded according to the protocol. Vital signs and adverse events were monitored and recorded regularly during the operation.Postoperative vital signs, postoperative analgesia time, duration of brachial plexus sensationsensory and motion block, postoperative nausea and vomiting score, dosage of remedial analgesics and adverse events were assessed and recorded in 24 hours after surgery. Results In terms of sensory and motor onset time of brachial plexus, duration of sensory and motor block and postoperative analgesia, DEX group was longer than the control group, with statistical differences (P<0.05).There were no significant statistical differences between the two groups in postoperative vital signs, the amount of remedial analgesic drugs, postoperative nausea and vomiting scores, adverse events etc(P>0.05). Conclusion As an adjuvant, dexmedetomidine (30 μg) can accelerate the onset time of ropivacaine in the supraclavicular approach of brachial plexus block.It can also increase the postoperative analgesia time and sensory and motor block time of brachial plexus.With less impact on the vital signs of patients, the efficacy and clinical safety of dexmedetomidinecan be found in our study.

目的 探讨不同年龄儿童性早熟的影响因素及预防措施。方法 本文将2020年1月—2021年1月的性早熟儿童45例(观察组)与正常健康儿童45例(对照组)作为研究对象,通过问卷调查的形式了解所选儿童的家庭因素、饮食、生活方式与社会因素等方面的情况,通过单因素分析与多因素分析探讨相关影响因素。结果 观察组不同年龄段儿童在骨龄、身高、体质量、BMI方面存在统计学差异,P＜0.05;观察组性激素水平明显高于对照组,P＜0.05。结论 儿童性早熟的发生与生活习惯、家庭关系、饮食习惯、母亲初潮年龄等因素有关,帮助其养成科学合理的生活习惯与饮食习惯,改善家庭关系可很好的降低并预防儿童性早熟的发生。对于已经出现性早熟现象的儿童来说,学校与家庭要及时给予其合理的健康教育,包括心理方面与生殖健康方面,及时有效的疏导可有效避免性早熟对儿童心理方面造成不良影响。

Objective To explore the influencing factors and preventive measures of precocious puberty in children of different ages. Methods 45 cases of precocious puberty children (observation group) and 45 cases of normal healthy children (control group) from January 2020 to January 2021 were selected as the research objects. The family factors, diets, lifestyles and social factors of the selected children were investigated by questionnaire survey, and the related influencing factors were discussed by single factor analysis and multi factor analysis. Results There were statistical differences in bone age, height, weight and BMI among children of different ages in the observation group, P<0.05. The levels of sex hormones in the observation group were higher than those in the control group, P<0.05. Conclusion The occurrence of children's precocious puberty is related to living habits, family relations, eating habits, mother's menarche ages and other factors. To help them develop scientific and reasonable living habits and dietary habits and improve family relations can reduce and prevent the occurrence of children's precocious puberty. For children with precocious puberty, schools and families should give them proper health education in time, including psychological and reproductive health. Timely and effective counseling can effectively avoid the adverse effects of precocious puberty on children's psychology.